In congenital talipes equinovarus (CTEV), the Pirani scoring system is used. The Ponseti method of serial casting corrects deformities in a specific sequence. What is the correct sequence of correction?
- A Equinus → Varus → Adductus → Cavus
- B Varus → Equinus → Adductus → Cavus
- C Adductus → Cavus → Equinus → Varus
- D Cavus → Adductus → Varus → Equinus (CAVE sequence) ✓
Explanation
The Ponseti technique corrects CTEV deformities in the CAVE sequence: Cavus first (by supinating the forefoot to align with the hindfoot, elevating the first metatarsal), then Adductus (abducting the forefoot around the talus), then Varus (hindfoot varus corrects as abduction proceeds), and finally Equinus (after varus is corrected, the equinus is treated — usually 80% require percutaneous Achilles tenotomy for final correction). Attempting to correct equinus first before varus tightens the heel cord incorrectly and creates a rocker-bottom deformity. This CAVE sequence is a high-yield exam fact.
Reference: Maheshwari Essential Orthopaedics, 6th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.